File picture: Oupa Mokoena, African News Agency (ANA)
AS INTERNATIONAL Nurses Day was observed globally this week, the Rural Health Advocacy Project (RHAP), a division of Wits Health Consortium (PTY) Ltd, released a report on the challenges of the rural health system nursing community programme.
The report was compiled by Karessa Govender, with inputs from Lungile Gamede and Eunice Montso.
According to the National Department of Health, nurses account for 56% of the health workforce and are integral to the primary health care (PHC) approach within the district health system framework.
In 2020, the Hospital Association of South Africa said the country had a shortage of between 26,000 and 62,000 professional nurses, and that by 2030 the demand for nurses in South Africa would increase to between 305,000 and 340,000.
According to the report, unless the nursing shortage is addressed, and very soon, it will jeopardise the realisation of Universal Health Coverage (UHC).
It said the bulk of the South African health workforce is concentrated in the private sector which provides healthcare to 27% of the population, while 63.9% work within the public sector and a very small proportion are specialist nurses.
“Rural regions fare poorly in key health indicators. According to the District Health Barometer 2019/20, rural districts are in the majority among the 10 worst-performing districts in both maternal and neonatal health,” the report read.
A persistent shortage of nurses threatens the achievement of key sustainable development goal targets such as those concerning maternal and child health. The community service programme injects health professionals into the public health system every year.
“In 2020, 2,724 professional nursing graduates from universities and nursing colleges were eligible for community service – a marginal increase over the previous year’s total of 2,709.
“The total number of nurses currently registered is approximately 280,231, which represents all categories of nurses. Of this number, 186,000 are in clinical practice and 154,024 are professional nurses.
“By 2030, we will require 305,000 to 340,000 professional nurses, but it is estimated that only 26,000 nurses will be trained by then,” the report read.
It also touched on the issue that the majority of nurses currently employed are over the age of 50, while only 6% are under the age of 30.
“Of all enrolled nurses registered with the South African Nursing Council (SANC) 27% are in the 50 to 59 age band, which means they are either close to retirement age, eligible for retirement, or past retirement age,” the report read.
It further tracked an upward trend in nursing training from 2000 to 2015, which was followed by a decline that was aggravated by a shortage of accredited nursing education institutions.
It stated the nursing profession is inadequately skilled.
According to statistics from the Department of Health in 2020, it said there was an under-supply of 18,000 to 29,000 professional nurses and 17,000 to 33,000 enrolled nurses and an excess of 9,000 nursing assistants.
“This was highlighted in 2021 when hospitals in a South African metro in KwaZulu-Natal was unable to admit patients who needed high and critical care because of a shortage of ICU-trained nurses. This was particularly significant, since metros generally have higher numbers of specialist nurses.
“Large numbers of nurses are also unemployed because of mismatches between the categories of nurses being trained and the categories of nurses needed, inconsistent and poor-quality training, the reluctance of nurses to work in rural and remote areas, and unfunded vacancies in the public sector.
“Unless the nursing shortage is addressed, and very soon, it will jeopardise realisation of universal health coverage and key sustainable development goals.
“Rural areas dominate the 10 worst-performing districts in maternal and infant health. Nursing plays an integral role in maternal and infant health as well as other key health indicators.
“If the demographic transition within the nursing profession is not addressed, we will not achieve its sustainable development goals (of reducing the mortality target and ending all preventable deaths under five years of age) for maternal and infant health,” the report read.
It said across the world, mandatory community service is used to recruit health workers to rural and remote areas.
South Africa’s community service policy is yet to be drafted.
“The National Department of Health is to review the community service programme to determine its value in capacitating rural health systems.
“In recent years, the health department has struggled to meet its obligation to fund the community service programme.
“Although the Human Resources Capacitation Grant has been used to fund both internship and community service programmes, austerity measures arising from persistent economic recession have led to the tightening of health budgets, and although community service is pro-rural, there is no incentive for rural provinces to fund posts with competing financial demands.
“Rural recruitment and retention thus depend on precarious funding streams from already incapacitated provinces,” the report stated.